June 21, 2006

How the Mentally Ill Are Treated

Since there isn't enough to be horrified about these days, read this St. Louis Post-Dispatch investigation into the abuses taking place in Missouri's mental institutions. Thousands of "mentally retarded and mentally ill people... have been sexually assaulted, beaten, injured and left to die by abusive and neglectful caregivers." The public tends not to find out about this stuff thanks to "secrecy laws, shoddy investigations and ambivalent police and prosecutors." Every year, meanwhile, state officials promise to "do better." Here's what doing better entails:

In 2002, a privately run home in Bolivar let a man's bed sores rot his flesh so badly that he died. Two years earlier, state workers repeatedly and severely beat mentally retarded boys in Marshall....

One mentally retarded man [in a facility near Overland] prone to swallowing things died in November after swallowing an ink pen. The resident, Michael Pallme, was supposed to be watched constantly.

Another patient, Rudy Wallace, died in March from burns so severe his skin began falling off after a worker left him in scalding water.

But those incidents are only a fraction of what has occurred inside the state and private facilities that house more than 11,000 state residents who have the most severe cases of mental retardation, developmental disabilities and mental illness.

Now in a country where pundits will applaud one presidential candidate for flying back to Arkansas to execute a functionally-retarded criminal and where another president orders the torture of a mentally-disturbed prisoner so as not to "lose face", maybe this won't come as a surprise, but it should still be intolerable.

Some very cursory searching on Google and Nexis didn't bring up any similar stories about mental institutions in other states, but I'm probably looking in the wrong place. The largest "institutions" in the country nowadays are prisons, which house some 300,000 people with mental disorders, and tend to have poor mental-health services and plenty of abuse to go around. In 2003, Human Rights Watch did a report on prisoners with mental illnesses:

In the most extreme cases, conditions are truly horrific: mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls.... Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.

It doesn't even take "the most extreme cases" to see things are bad. From people who have worked closely on this issue, I've heard plenty of stories of, say, prisoners who simply won't be "officially" classified as mentally ill despite plenty of evidence to the contrary, and will then get written up by guards at the first outburst of strange behavior (say, compulsive masturbating in their cell), leading to longer prison sentences. Is this likely to make things a) better or b) worse? Yeah, I wonder too.

A summary of the HRW report is here. Among other things, HRW notes that until this country gets serious about the community mental health systems that were supposed to replace mental hospitals after "deinstitutionalization" in the 1960s, prisons will continue to serve as mental institutions of last resort. I'd like to know what effects the Mentally Ill Offender Treatment and Crime Reduction Act, passed by Congress in 2004, has had but perhaps it's too early to tell. It also appears that the "war on drugs," the gift that keeps on giving, has disproportionately affected the mentally ill as the prison population continues to grow and grow without end.